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à At the end of the discussion, the student will be able to:
à c c c
ÿ Second phase of the Perioperative Nursing
ÿ Known as " Operating Room Nursing "
ÿ Basic Nursing Responsibilities during Intraoperative :
1. Surgeon
2. Anesthesiologist
3. Circulating Nurse
4. Scrub person or surgical technologist
5. Assisstant
à
à Before surgeon arrives:
a. Do a complete scrub according to the institutional procedure.
b. Gown and glove from a surface separate from the intended sterile field.
c. Drape tables as necessary according to institutional policy.
d. Count sponges, surgical needles and other sharps and instrument with the
circulator according to established institutional policy and procedure.
e. Arrange instrument and accessory items on the mayo stand for making and
opening the initial incision.
à
c
1. Cutting or Dissecting knives and scissors.
2. Grasping and Folding Tissue forcep.
3. Clamping and Occuluding Hemostatic forceps and clamps.
4. Exposing retractors.
5. Suturing needle holder.
à
à a. Gown and glove the surgeon and assistant as soon after they
enter the room.
à b. Assist in draping the patient according to routine procedure.
à c. Bring the mayo stand into position over the patient after draping
is completed.
à
à Best suited for surgery of the head, neck, upper torso, back, prolonged
surgical procedure. Client who are unable to lie quietly fro prolonged
period of time.
à %
à 1. Intravenous
à rapid introduction
à unconsciousness, generally occurs about 30mins.
à Commonly used as an induction agent before inhalation anesthesia is
given.
à Used for dental extraction, pelvic examination.
à x c
à Mixture of volatile liquid or gas and oxygen.
à Given through mask or endotracheal tube.
à Advantageous because of the case of administration and elimination through
respiration system.
à Nitrous oxide commonly used gas anesthesia.
à IV anesthesia is often administered before the use of inhalation
anesthetics-promotes rapid transition from the conscious stage to the
surgical anesthesia stage.
à
à 1.
via rectal tube.
à 2.
c and are given mainly to facilitate intubations,
relax the muscle within the surgical field ease laryngospasm, and relax
muscle for controlled ventilation.
à Regional Anesthesia is useful in many clinical situations.
à
à %
(
a. Directly applied to the area.
b. Is most often applied to the respiratory passages to eliminate laryngeal
reflexes of cough for insertion of airways before induction or during
light general anesthesia or for therapeutic and diagnostic procedure
such as bronchoscope or laryngoscope.
c. Ointment, solution, gel, cream or powder.
d. Used for minor surgery such as rectal exam when painful hemorrhoids
are present, bronchoscope.
c
a. Involved injection of anesthesia agent such as lidocaine into the skin
and subcutaneous tissue.
b. Blocks only the peripheral nerves around the area of incision.
c. Physician should not allow the needle to slip into one of the veins-it
may cardiovascular collapse or convulsions.
d. Physician always aspirate before injection to ensure the needle is not in
a vein.
Method of accounting for items put on sterile table performed by scrub nurse and
circulating nurse.
a. FIRST COUNT (Person who wraps items for sterilization counts them
in standardized multiple units)
b. SECOND COUNT (Circulating and Scrub Nurse count together when
packages are open before OR begins)
c. THIRD COUNT (Counts are taken in 3 areas when surgeon starts
wound closure)
d. FOURTH COUNT (Before incision is closed)
ÿ
#1
1. All plugs and wires are inspected for correct attachments.
2. All working equipment is checked to ensure good working order.
3. Grounding of all electrical equipment is essential for safety and prevention of
stray leakage current.
à
c ! c
ÿ Ensures sterility of all instruments and supplies.
ÿ Key words in Operating Room Practice (Caring, Conscience,
Discipline, and Technique)
à !
à One's inner voice for conscientious practice of asepsis and
steriletechnique at all times.
à c c
" c "c
à Malnutrition
à Age
à Obesity
à Chronic Diseases
à Remote Infections
à Impaired Defense Mechanisms
à Cardiovascular and Respiratory Determinants
à Lengthy Preoperative Stay
à Types of Operation
à Duration of Operation
à Operative Technique
à Indiscriminate Use of Antibiotics
à c c !& c" c !"!, !c "c
à
à Õ Malignant HyperthermiaÕ
à 1. Genetic disorder characterized by uncontrolled skeletal muscle
contraction leading to fatal hyperthermia
à 2. Occurs in combination with succinnylcholine and halothane
anesthetics and within 30 minutes of anesthesia induction.
à 3. Signs and symtoms : Increase end tidal oxygen; masseter muscle
rigidity cardiac dysrhythmias; hypermetabolic rate
à 4. Treatment: Datrolene (Muscle relaxant)
à & c !"!c c!
Time patient arrived in and departed from OR
Level of consciousness or anxiety manifested by observable physical
responses
Site, time started, type of needle or cannula, solutions administered
intravenously including blood products.
Position and type of restraints and supports
Skin condition and antiseptics
Location of electrosurgical grounding and monitoring electrodes
Operation performed
Specimen and cultures sent to laboratory.
Medications given and anesthetics used
Sites and types of drains applied
Type of dressing applied
Unusual incident or complications
à &c
! ! c
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à ÿ Wiping of any excess blood, skin preparation and debris from the
patient's skin
à ÿ Provide clean gown and blanket on patient.
à ÿ Enough personnel for moving and transporting.
à ÿ Avoid rapid movements in changing the patient's position.
à ÿ Watch out for effects of anesthesia.
à ÿ Careful with devices attached to patients
à ÿ Provide privacy in transfer, avoid rough handling may damage fragile
skin.
à ÿ Provide privacy in transfer; avoid rough handling my damage fragile
skin.
à ÿ Provide warm blanket and secure safety belts and siderails.